Diagnostics and treatment of gastroesophageal reflux disease: clinical guidelines of the Russian gastroenterological association
Aim of publication. To present the latest data on adequate diagnostic methods, treatment approaches and features of rational pharmacotherapy of gastroesophageal reflux disease (GERD) based on the principles of evidencebased medicine to general practitioners. Summary. The prevalence of GERD occupies...
Saved in:
| Main Authors: | , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | Russian |
| Published: |
Gastro LLC
2018-08-01
|
| Series: | Российский журнал гастроэнтерологии, гепатологии, колопроктологии |
| Subjects: | |
| Online Access: | https://www.gastro-j.ru/jour/article/view/171 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1823860308516536320 |
|---|---|
| author | V. T. Ivashkin I. V. Mayev I. . A.s. Trukhmanov Ye. K. Baranskaya O. B. Dronova O. V. Zayratyants R. G. Sayfutdinov A. A. Sheptulin T. L. Lapina S. S. Pirogov Yu. A. Kucheryavy O. A. Storonova D. N. Andreyev |
| author_facet | V. T. Ivashkin I. V. Mayev I. . A.s. Trukhmanov Ye. K. Baranskaya O. B. Dronova O. V. Zayratyants R. G. Sayfutdinov A. A. Sheptulin T. L. Lapina S. S. Pirogov Yu. A. Kucheryavy O. A. Storonova D. N. Andreyev |
| author_sort | V. T. Ivashkin |
| collection | DOAJ |
| description | Aim of publication. To present the latest data on adequate diagnostic methods, treatment approaches and features of rational pharmacotherapy of gastroesophageal reflux disease (GERD) based on the principles of evidencebased medicine to general practitioners. Summary. The prevalence of GERD occupies the first place of other gastroenterological diseases. The heartburn that is a leading GERD symptom is present at 20-40% of the population of developed countries. The prevalence of GERD in Russia ranges 1846%. Diagnosis of GERD early stages is based on the primary appealability and clinical presentation evaluation. Esophagogastroduodenoscopy (EGDS) gives the chance to define the presence of reflux esophagitis, to estimate severity grade, to reveal development of esophageal epithelium columnar metaplasia. At the refractory course (lack of conclusive clinical and endoscopic remission within 4-8 wks of treatment by standard dose of proton pump inhibitor - PPI), and development of complications (strictures, Barret's esophagus) examination within specialized hospital or gastroenterological clinic is required, including their outpatient departments. Under certain indications the patient should undergo EGDS with esophageal biopsy and histological examination of biopsy specimens to rule out the Barret's esophagus, esophageal adenocarcinoma and/or eosinophilic esophagitis; intraesophageal 24hour pHmetry or pHimpedance measurement; high resolution esophageal manometry; Xray study of the esophagus and stomach. The treatment of GERD has to be individualized according to the pattern and severity of clinical symptoms. The goal of treatment is symptom relief, at erosive esophagitis - healing of erosions and complication prevention, at Barret's esophagus - prophylaxis of disease progression and dysplasia and adenocarcinoma development. Nowadays PPIs are considered as the most effective and safe agents for GERD treatment. PPIs are applied for the longterm baseline treatment (no less than 4-8 wks) and maintenance therapy (6-12 months). Intake of alginates is pathogenically reasonable therapeutic approach for reduction of «acid pocket» and acid neutralization in the area of gastroesophageal junction in GERD patients by formation of mechanical barrier raft which prevents reflux of the stomach content into the esophagus. Antacid monotherapy is recommended for the cases of rare heartburn which is not accompanied by esophagitis and in complex modes of GERD treatment for achievement of rapid symptom relief. Adsorbents are applied as monotherapy at non erosive reflux disease, and as a component of comprehensive GERD treatment, especially of the cases of mixed (acid + biliary) refluxes. Prokinetic drugs promote recovery of a normal physiological state of the esophagus, controlling the pathogenic mechanisms of GERD, reducing the number of transient lower esophageal sphincter relaxations and improving esophageal clearance due to stimulation of the lower gastrointestinal motor function. Prokinetics can be applied as a component of comprehensive treatment of GERD along with PPI. Antireflux surgery is indicated in complicated cases (recurrent bleeding, peptic esophageal strictures, development of Barret's esophagus with highgrade epithelial dysplasia, frequent aspiration pneumonias). Surgical treatment of GERD is more effective in patients was typical manifestations and positive treatment response to PPIs. Conclusion. Implementation of clinical guidelines can promote improvement of healthcare quality for GERD patients and prevent complications, in particular if terms of treatment will be observed, at active outpatient followup for certain groups of patients. |
| format | Article |
| id | doaj-art-c87f759dfe994498a3221ba894cdd6ef |
| institution | Kabale University |
| issn | 1382-4376 2658-6673 |
| language | Russian |
| publishDate | 2018-08-01 |
| publisher | Gastro LLC |
| record_format | Article |
| series | Российский журнал гастроэнтерологии, гепатологии, колопроктологии |
| spelling | doaj-art-c87f759dfe994498a3221ba894cdd6ef2025-02-10T16:14:28ZrusGastro LLCРоссийский журнал гастроэнтерологии, гепатологии, колопроктологии1382-43762658-66732018-08-01274759510.22416/1382-4376-2017-27-4-75-95171Diagnostics and treatment of gastroesophageal reflux disease: clinical guidelines of the Russian gastroenterological associationV. T. Ivashkin0I. V. Mayev1I. . A.s. Trukhmanov2Ye. K. Baranskaya3O. B. Dronova4O. V. Zayratyants5R. G. Sayfutdinov6A. A. Sheptulin7T. L. Lapina8S. S. Pirogov9Yu. A. Kucheryavy10O. A. Storonova11D. N. Andreyev12Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical UniversityFederal state government-financed educational institution of higher education «Yevdokimov Moscow State University of Medicine and Dentistry»Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical UniversityFederal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical UniversityFederal state government-financed educational institution of higher education «Orenburg State Medical University»Federal state government-financed educational institution of higher education «Yevdokimov Moscow State University of Medicine and Dentistry»Federal state government-financed educational institution of higher education «Kazan state medical university»Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical UniversityFederal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical UniversityGertsen Moscow oncological research instituteFederal state government-financed educational institution of higher education «Yevdokimov Moscow State University of Medicine and Dentistry»Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical UniversityFederal state government-financed educational institution of higher education «Yevdokimov Moscow State University of Medicine and Dentistry»Aim of publication. To present the latest data on adequate diagnostic methods, treatment approaches and features of rational pharmacotherapy of gastroesophageal reflux disease (GERD) based on the principles of evidencebased medicine to general practitioners. Summary. The prevalence of GERD occupies the first place of other gastroenterological diseases. The heartburn that is a leading GERD symptom is present at 20-40% of the population of developed countries. The prevalence of GERD in Russia ranges 1846%. Diagnosis of GERD early stages is based on the primary appealability and clinical presentation evaluation. Esophagogastroduodenoscopy (EGDS) gives the chance to define the presence of reflux esophagitis, to estimate severity grade, to reveal development of esophageal epithelium columnar metaplasia. At the refractory course (lack of conclusive clinical and endoscopic remission within 4-8 wks of treatment by standard dose of proton pump inhibitor - PPI), and development of complications (strictures, Barret's esophagus) examination within specialized hospital or gastroenterological clinic is required, including their outpatient departments. Under certain indications the patient should undergo EGDS with esophageal biopsy and histological examination of biopsy specimens to rule out the Barret's esophagus, esophageal adenocarcinoma and/or eosinophilic esophagitis; intraesophageal 24hour pHmetry or pHimpedance measurement; high resolution esophageal manometry; Xray study of the esophagus and stomach. The treatment of GERD has to be individualized according to the pattern and severity of clinical symptoms. The goal of treatment is symptom relief, at erosive esophagitis - healing of erosions and complication prevention, at Barret's esophagus - prophylaxis of disease progression and dysplasia and adenocarcinoma development. Nowadays PPIs are considered as the most effective and safe agents for GERD treatment. PPIs are applied for the longterm baseline treatment (no less than 4-8 wks) and maintenance therapy (6-12 months). Intake of alginates is pathogenically reasonable therapeutic approach for reduction of «acid pocket» and acid neutralization in the area of gastroesophageal junction in GERD patients by formation of mechanical barrier raft which prevents reflux of the stomach content into the esophagus. Antacid monotherapy is recommended for the cases of rare heartburn which is not accompanied by esophagitis and in complex modes of GERD treatment for achievement of rapid symptom relief. Adsorbents are applied as monotherapy at non erosive reflux disease, and as a component of comprehensive GERD treatment, especially of the cases of mixed (acid + biliary) refluxes. Prokinetic drugs promote recovery of a normal physiological state of the esophagus, controlling the pathogenic mechanisms of GERD, reducing the number of transient lower esophageal sphincter relaxations and improving esophageal clearance due to stimulation of the lower gastrointestinal motor function. Prokinetics can be applied as a component of comprehensive treatment of GERD along with PPI. Antireflux surgery is indicated in complicated cases (recurrent bleeding, peptic esophageal strictures, development of Barret's esophagus with highgrade epithelial dysplasia, frequent aspiration pneumonias). Surgical treatment of GERD is more effective in patients was typical manifestations and positive treatment response to PPIs. Conclusion. Implementation of clinical guidelines can promote improvement of healthcare quality for GERD patients and prevent complications, in particular if terms of treatment will be observed, at active outpatient followup for certain groups of patients.https://www.gastro-j.ru/jour/article/view/171гастроэзофагеальная рефлюксная болезньгастроэзофагеальный рефлюксрефлюкс-эзофагитнеэрозивная рефлюксная болезнь«кислотный карман»ингибитор протонной помпыальгинатангтацидпрокинетический препарат |
| spellingShingle | V. T. Ivashkin I. V. Mayev I. . A.s. Trukhmanov Ye. K. Baranskaya O. B. Dronova O. V. Zayratyants R. G. Sayfutdinov A. A. Sheptulin T. L. Lapina S. S. Pirogov Yu. A. Kucheryavy O. A. Storonova D. N. Andreyev Diagnostics and treatment of gastroesophageal reflux disease: clinical guidelines of the Russian gastroenterological association Российский журнал гастроэнтерологии, гепатологии, колопроктологии гастроэзофагеальная рефлюксная болезнь гастроэзофагеальный рефлюкс рефлюкс-эзофагит неэрозивная рефлюксная болезнь «кислотный карман» ингибитор протонной помпы альгинат ангтацид прокинетический препарат |
| title | Diagnostics and treatment of gastroesophageal reflux disease: clinical guidelines of the Russian gastroenterological association |
| title_full | Diagnostics and treatment of gastroesophageal reflux disease: clinical guidelines of the Russian gastroenterological association |
| title_fullStr | Diagnostics and treatment of gastroesophageal reflux disease: clinical guidelines of the Russian gastroenterological association |
| title_full_unstemmed | Diagnostics and treatment of gastroesophageal reflux disease: clinical guidelines of the Russian gastroenterological association |
| title_short | Diagnostics and treatment of gastroesophageal reflux disease: clinical guidelines of the Russian gastroenterological association |
| title_sort | diagnostics and treatment of gastroesophageal reflux disease clinical guidelines of the russian gastroenterological association |
| topic | гастроэзофагеальная рефлюксная болезнь гастроэзофагеальный рефлюкс рефлюкс-эзофагит неэрозивная рефлюксная болезнь «кислотный карман» ингибитор протонной помпы альгинат ангтацид прокинетический препарат |
| url | https://www.gastro-j.ru/jour/article/view/171 |
| work_keys_str_mv | AT vtivashkin diagnosticsandtreatmentofgastroesophagealrefluxdiseaseclinicalguidelinesoftherussiangastroenterologicalassociation AT ivmayev diagnosticsandtreatmentofgastroesophagealrefluxdiseaseclinicalguidelinesoftherussiangastroenterologicalassociation AT iastrukhmanov diagnosticsandtreatmentofgastroesophagealrefluxdiseaseclinicalguidelinesoftherussiangastroenterologicalassociation AT yekbaranskaya diagnosticsandtreatmentofgastroesophagealrefluxdiseaseclinicalguidelinesoftherussiangastroenterologicalassociation AT obdronova diagnosticsandtreatmentofgastroesophagealrefluxdiseaseclinicalguidelinesoftherussiangastroenterologicalassociation AT ovzayratyants diagnosticsandtreatmentofgastroesophagealrefluxdiseaseclinicalguidelinesoftherussiangastroenterologicalassociation AT rgsayfutdinov diagnosticsandtreatmentofgastroesophagealrefluxdiseaseclinicalguidelinesoftherussiangastroenterologicalassociation AT aasheptulin diagnosticsandtreatmentofgastroesophagealrefluxdiseaseclinicalguidelinesoftherussiangastroenterologicalassociation AT tllapina diagnosticsandtreatmentofgastroesophagealrefluxdiseaseclinicalguidelinesoftherussiangastroenterologicalassociation AT sspirogov diagnosticsandtreatmentofgastroesophagealrefluxdiseaseclinicalguidelinesoftherussiangastroenterologicalassociation AT yuakucheryavy diagnosticsandtreatmentofgastroesophagealrefluxdiseaseclinicalguidelinesoftherussiangastroenterologicalassociation AT oastoronova diagnosticsandtreatmentofgastroesophagealrefluxdiseaseclinicalguidelinesoftherussiangastroenterologicalassociation AT dnandreyev diagnosticsandtreatmentofgastroesophagealrefluxdiseaseclinicalguidelinesoftherussiangastroenterologicalassociation |